Is the US an appropriate place to hold an international AIDS conference?

Spurred by the unrelenting human toll of HIV and launched as a call for global solidarity, the first World AIDS Day on Dec. 1, 1988, became the first day of commemoration to recognize the global impact of any disease. This World AIDS Day, 30 years later, comes with the theme “know your status.” It finds us with proven therapeutic and prevention tools at hand to curtail new cases of HIV and demonstrated success in using those tools. Solidarity, however, remains more of a vision than a reality.

This World AIDS Day again finds the United States as a recognized leader of the global AIDS response, but at the same time a controversial choice as host of the next International AIDS Conference, which is scheduled for July 2020 in Oakland and San Francisco. Some of the objections are long-standing, with issues raised in 2012, the last time the conference was held in the U.S., remaining unresolved, including a federal travel ban barring entry to people who have earned income through sex work and people who have used illegal drugs. Other concerns are new, with legislation proposed by the current administration to deny green cards to individuals who may accessed non-emergency.Medicaid services or other assistance programs, in addition to new entry restrictions placed by the administration in the last two years keeping out people from Muslim majority countries.

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All of the objections pertain to conditions and policies that would keep people pivotally involved in the global AIDS response, including affected communities to scientists, physicians and nurses, from feeling safe or welcomed here. Similar conditions and policies also continue to undermine efforts to end the HIV epidemic at home.

For a start, while the theme of this World AIDS Day “know your status” encourages all people to get tested for HIV, the United States leads the world in creating and preserving disincentives to do so. Antiquated, non-science-based, HIV-specific criminalization laws persist on the books across more than three-quarters of the nation These outdated and unnecessarily punitive statutes only add to the destructive and undeserved stigma that people living with HIV continue to face.

These laws, which criminalize acts that supposedly expose others to the virus — including spitting (which does not transmit HIV) and not disclosing one’s status — have long been recognized as obsolete, both by having been superseded by scientific evidence and also by having been shown to only create more barriers to HIV testing.

Most recently, multiple human studies of treatment for HIV that suppresses the virus to undetectable levels in the blood and sexual fluids has given birth to a novel take-away moniker — “U = U” — an undetectable virus is non-transmissible — and has been endorsed by the International AIDS Society, by National Institute of Allergy and Infectious Diseases Director Dr. Anthony Fauci and Centers for Disease Control and Prevention Director Dr. Robert Redfield — remove any excuse for keeping those laws on the books.

At the same time, attacks on the most marginalized and affected populations at-risk for HIV in the U.S. continues to be fueled by administration proposals to deny the existence of transgender people. Fortifying the walls between access to health care, housing and employment services and transgender women, one of the most highly affected and at-risk populations in the U.S. and around the world, only further stigmatizes these persons and drives them away from health services.

These inhumane and discriminatory policies developed by the U.S. are not lost on the rest of the world and are often replicated and amplified in other countries. Even now, far into a response that, with ample U.S. support was gaining ground, the government of Tanzania is choosing to sabotage its own success against HIV with a “crackdown” or accelerated persecution of gay people. While the State Department did, recently, condemn that persecution, it failed to recognize in its remarks the effects of institutionalized bigotry and violence on health.

This year, in the midst of a still escalating opioid crisis, the United States, with the SUPPORT Act, recognized the links between injecting drug use and infectious diseases including HIV. And yet still, this country lags well behind both developed and resource-limited countries in providing access to proven preventive measures that include safe injection sites, needle and syringe service programs and medication assisted therapy to treat substance use disorders.

It should not be surprising then, that many respected scientists, advocates, researchers, physicians and organization leaders do not believe that the United States is an appropriate place to hold an International AIDS Conference. It comes as a unwelcomed distinction that among developed countries the United States has one of the highest rates of new HIV cases and the highest proportion of people living with HIV. This World AIDS Day, the U.S. should know and own, its status as a global leader of health responses and reverse the policies that compromise its leadership.

David Hardy, MD is chair of the HIV Medicine Association and serves as an adjunct professor of medicine at Johns Hopkins University School of Medicine in the division of infectious diseases. He has cared for persons with HIV infection since 1982 and conducted research on the disease since 1984.